Gerard explores how pharma companies lose billions each year through copay program inefficiencies, accumulators, maximizers, and other forms of systemic leakage. He introduces RIS Rx, a healthcare technology company whose platform helps manufacturers mitigate gross-to-net (GTN) revenue leakage while supporting patient access and outcomes.
Click here to request a free savings snapshot from the RIS Rx platform for your brand.
Read on for Gerard’s insights.
The $90 Billion Leakage Problem: How RIS Rx Helps Pharma Recover Lost Revenue
By Gerard Rivera, CEO and Co-Founder, RIS Rx
Every year, billions of dollars meant to support patients don’t make it anywhere near them.
Instead, those dollars vanish into a maze of copay program rules, accumulators, maximizers, and inefficiencies. For manufacturers, it’s lost profit. But for patients, it can mean walking away from the pharmacy counter without the medication they need.
That reality is painful. And it’s anything but abstract for me.
Before I co-founded RIS Rx, I was a frontline pharmacist. I saw the faces of patients making hard choices every day. Sometimes a $50 copay card meant the difference between starting therapy or going home empty-handed.
Later, when I began working with pharma executives managing billion-dollar copay budgets, I realized something shocking: the inefficiencies I saw on the ground weren’t inevitable. They were baked into the way the system was designed.
That realization became the spark for RIS Rx.
How Two Pharmacists Cracked the Gross-to-Net (GTN) Code
My co-founder, Stephen Hom, and I met in pharmacy school. We both entered the profession with the same belief: put patients first.
On the front lines, we saw the “prescription lifecycle" through the lens of pharmacists: the questions, the delays, the relief when a copay card kicked in. Years later, we saw how copay cards were actually built from the perspective of executives: the rules, the structures, the blind spots.
When we married those two perspectives—the patient experience at the pharmacy counter and the executive view of program design—it was clear there had to be a better way.
That’s why we launched RIS Rx in 2020, at the very start of the pandemic. Within weeks of going live with our first customer, we were already seeing meaningful savings.
That early success set the tone for everything that’s followed.
The $90 Billion Problem Nobody Can Ignore
Leakage today is more urgent than ever. Profitability in pharma is at historic lows, and GTN has become a mandatory board-level agenda item.
The numbers speak for themselves: in 2024, pharma spent about $55 billion on patient affordability programs. Roughly $11 billion of that leaked out, according to Health Management Associates. When 340B and rebates are accounted for, that number rises to an astounding $90 billion.
With the GTN bubble increasing and impacting pharma’s profits, it’s more important than ever for manufacturers to know that their funds are being properly allocated.
This issue affects real manufacturers despite what they think are their best efforts. Just one case in point: Against copay assistance spend totaling $200 million, RIS Rx realized $100 million in savings so far this year for a single manufacturer, exceeding both client expectations and internal projections. That’s the scale of leakage hiding in plain sight.
Clearly, we can’t ignore this $90 billion problem. And thankfully, the challenges aren’t insurmountable.
Why Real-Time Beats Retroactive Every Time
What makes leakage especially challenging is its shape-shifting nature. First, we saw accumulator programs. Then maximizers. Then “variable benefit maximizers” that more aggressively grabbed value on the very first fill.
Legacy solutions tried to fix leakage by throwing people at it. That meant audit-heavy, FTE-heavy, and painfully slow processes. Three- or six-month lookbacks were the norm. By the time a manufacturer saw what was wrong, the money was already gone.
RIS Rx was built differently.
- Real-time impact. We deliver results within weeks. In 2024, our customers saved $450 million. In 2025, we’re forecasting over $1 billion in recovered value.
- Seamless integration. No lift-and-shift. We work with your existing hub and copay vendors, mapping data feeds quickly without disrupting patients or providers.
- Dynamic rules engine. Leakage evolves. Our platform evolves with it. Accumulators, maximizers, variable benefit maximizers: we stay in lockstep.
- Unprecedented data vantage point. As a co-vendor with hubs and copay programs, we see the ecosystem from a rare perspective. Our data flywheel lets us benchmark and enhance performance in ways no one else can.
We’re investing in AI, expanding rule sets, and staying dynamic. That adaptability is the only way to keep patients, providers, and manufacturers one step ahead.
Our Rallying Cry: Every Dollar to the Patient
At our core, Stephen and I are still pharmacists. That means every conversation about leakage is really about patients. Every dollar saved is a dollar that can be redirected to someone who needs their therapy today, not tomorrow.
This impact on the lives of patients benefits the bottom line, too. As one CFO told us, “We expected this to be a cost center. Instead, it became a source of profitability.” That’s the power of recovering leakage at scale.
Our mission is simple and hasn’t changed: no patient left behind, and no dollar wasted.
Now It’s Your Turn: Get Your Free Savings Snapshot
We don’t just want to tell you this story; we want to show you. That’s why we’re offering a free savings snapshot.
Think of it as a fast, shareable view of where opportunity might exist in your copay programs. It’s easy to share with your CFO or leadership team. It’s concrete.
And it’s the first step toward making sure your dollars go where they belong: to patients.
See why we have a perfect NPS score: Click here to request your free savings snapshot.
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